NURS 422 FINAL EXAM WITH
COMPLETE SOLUTION
Viral meningitis - ANSWER most common; resolves w/o tmt
bacterial meningitis risk factors - ANSWER bacterial infections - upper
respiratory, Hib, Neisseria meningitidis
invasive procedures
skull fractures
crowded living conditions
bacterial meningitis s/sx - ANSWER severe HA, stiff neck, rapid breathing,
macular red rash, pale/blue skin, dusky around lips, cold hands/feet with
high temperature
bacterial meningitis lumbar puncture - ANSWER CSF fluid cloudy, increased
protein, decreased glucose, increased WBC
lumbar puncture procedure - ANSWER CT scan to rule out space-occupying
lesion, empty bladder, lie still in fetal position, client should report
shooting/tingling pain, apply pressure over site with sterile dressing; lie flat
4-8 hours post procedure
Brudzinski's sign (meningitis) - ANSWER knees and hips flex when neck is
flexed to sternum
Kernig's sign (meningitis) - ANSWER inability to straighten leg when
opposite hip is flexed to 90 degrees
,meningitis interventions - ANSWER HOB 30 degrees, decrease stimuli,
droplet precautions until abx for 24 hours, cooling blanket, prophylactic abx
for individuals in close contact, non-opioid analgesics for HA to avoid
changing LOC
seizure triggers - ANSWER hypoglycemia, stress, hyperventilation, fatigue,
Na/Ca/Mg imbalances
generalized seizures - ANSWER involves entire brain
tonic clonic seizure - ANSWER aura, tonic (stiffening/rigidity, immediate
LOC), clonic
(jerking of all extremities), incontinence, breathing irregularities
absence seizure - ANSWER periods of staring and loss of awareness
myoclonic seizure - ANSWER sudden uncontrolled jerking or stiffening of 1+
extremity (increase falls)
postictal - ANSWER after seizure; confusion, sleepiness
partial seizures - ANSWER begins in 1 hemisphere, less responsive to tmt
partial simple seizure - ANSWER NO LOC, aura, may have one sided
movement, autonomic symptoms
partial complex seizure - ANSWER altered LOC, patient is unaware of
environment
EEG pre-procedure - ANSWER NOT NPO to avoid hypoglycemia, shampoo,
no caffeine
seizure interventions - ANSWER keep airway patent, keep patient in
side-lying position, clear environment
, seizure precautions - ANSWER O2, airway, suction equipment, IV, side rails
up & padded, bed in lowest position
status epilepticus - ANSWER seizure lasting longer than 5 minutes or
repeated seizures over 30 minutes
status epilepticus interventions - ANSWER establish airway & IV, IV push
lorazepam or diazepam, administer dilantin/cerebyx afterwards to prevent
additional seizures
vagal nerve stimulator - ANSWER NOT for generalized seizures, patient
activates VNS when aura is present; experience change in voice when
activated
Romberg sign (brain tumor) - ANSWER close eyes and loss of balance =
positive
Babinski sign (brain tumor) - ANSWER big toe moves upwards and other toes
fan out
safety issues with brain tumor - ANSWER aspiration and falls
tumor above tentorium = cerebral - ANSWER severe HA in am, visual
changes, decreased motor ability, optic disk swelling, hyper/paresthesias,
aphasia, seizures, altered mental activity or personality
tumor below tentorium = cerebellum, brainstem - ANSWER hearing loss,
facial pain/weakness, ataxia, dysphagia, nystagmus, hoarseness, dysarthria,
ANS dysfunction
post-op above tentorium - ANSWER HOB 30 degrees
post-op below tentorium - ANSWER supine
COMPLETE SOLUTION
Viral meningitis - ANSWER most common; resolves w/o tmt
bacterial meningitis risk factors - ANSWER bacterial infections - upper
respiratory, Hib, Neisseria meningitidis
invasive procedures
skull fractures
crowded living conditions
bacterial meningitis s/sx - ANSWER severe HA, stiff neck, rapid breathing,
macular red rash, pale/blue skin, dusky around lips, cold hands/feet with
high temperature
bacterial meningitis lumbar puncture - ANSWER CSF fluid cloudy, increased
protein, decreased glucose, increased WBC
lumbar puncture procedure - ANSWER CT scan to rule out space-occupying
lesion, empty bladder, lie still in fetal position, client should report
shooting/tingling pain, apply pressure over site with sterile dressing; lie flat
4-8 hours post procedure
Brudzinski's sign (meningitis) - ANSWER knees and hips flex when neck is
flexed to sternum
Kernig's sign (meningitis) - ANSWER inability to straighten leg when
opposite hip is flexed to 90 degrees
,meningitis interventions - ANSWER HOB 30 degrees, decrease stimuli,
droplet precautions until abx for 24 hours, cooling blanket, prophylactic abx
for individuals in close contact, non-opioid analgesics for HA to avoid
changing LOC
seizure triggers - ANSWER hypoglycemia, stress, hyperventilation, fatigue,
Na/Ca/Mg imbalances
generalized seizures - ANSWER involves entire brain
tonic clonic seizure - ANSWER aura, tonic (stiffening/rigidity, immediate
LOC), clonic
(jerking of all extremities), incontinence, breathing irregularities
absence seizure - ANSWER periods of staring and loss of awareness
myoclonic seizure - ANSWER sudden uncontrolled jerking or stiffening of 1+
extremity (increase falls)
postictal - ANSWER after seizure; confusion, sleepiness
partial seizures - ANSWER begins in 1 hemisphere, less responsive to tmt
partial simple seizure - ANSWER NO LOC, aura, may have one sided
movement, autonomic symptoms
partial complex seizure - ANSWER altered LOC, patient is unaware of
environment
EEG pre-procedure - ANSWER NOT NPO to avoid hypoglycemia, shampoo,
no caffeine
seizure interventions - ANSWER keep airway patent, keep patient in
side-lying position, clear environment
, seizure precautions - ANSWER O2, airway, suction equipment, IV, side rails
up & padded, bed in lowest position
status epilepticus - ANSWER seizure lasting longer than 5 minutes or
repeated seizures over 30 minutes
status epilepticus interventions - ANSWER establish airway & IV, IV push
lorazepam or diazepam, administer dilantin/cerebyx afterwards to prevent
additional seizures
vagal nerve stimulator - ANSWER NOT for generalized seizures, patient
activates VNS when aura is present; experience change in voice when
activated
Romberg sign (brain tumor) - ANSWER close eyes and loss of balance =
positive
Babinski sign (brain tumor) - ANSWER big toe moves upwards and other toes
fan out
safety issues with brain tumor - ANSWER aspiration and falls
tumor above tentorium = cerebral - ANSWER severe HA in am, visual
changes, decreased motor ability, optic disk swelling, hyper/paresthesias,
aphasia, seizures, altered mental activity or personality
tumor below tentorium = cerebellum, brainstem - ANSWER hearing loss,
facial pain/weakness, ataxia, dysphagia, nystagmus, hoarseness, dysarthria,
ANS dysfunction
post-op above tentorium - ANSWER HOB 30 degrees
post-op below tentorium - ANSWER supine
